Complicated parapneumonic effusion: Etiology and results of lung decortication

Parapneumonic effusion is a common accompaniment of bacterial pneumonia and mostly is resolved with medical management. We studied the etiology and possible underlying causes of complicated parapneumonic effusion and timing of pulmonary decortication. A descriptive study on 34 patients with postpneumonic empyema which required decortication carried out. Post surgical and post traumatic empyema were excluded. Patients' age ranged from 20 to 75 with a mean of 46 years. The most common clinical findings were fever [90%], pleural dull pain [80%], productive cough [73%] and dyspnea [70%]. PPD test was negative in all patients. In 78%, white cell count was normal; in remainder it was more than 10.000. Bacteriological findings were negative and acid fast bacilli were not detected. All patients underwent posterolateral thoracotomy and decortication and completely expansible lung was achieved. Tissue diagnosis after decorticating showed tuberculosis in 8 [24%] patients and necrotic tissue in remainder. Average medical management time and postoperative hospital stay were 38 +/- 2 and 6.7 +/- 2 days, respectively. Morbidity rates were acceptable and there was one late mortality. No recurrence was happened. In parapneumonic effusions not responding to standard treatment, tuberculosis must be considered, especially in addicted persons, positive family history and ESR > 100. In complicated parapneumonic effusion, early thoracotomy and full decortication is recommend because it is diagnostic, allows control of infection, releases the pulmonary entrapment, early discharge from hospital, need not further antibiotic administration and is cost benefit

Treatment of cutaneous leishmaniasis in murine model by hydro alcoholic essence of Artemisia sieberi

Considering the prevalence of leishmaniasis in Iran and many side effects associated with pentavalent antimony compounds use in its treatment, this study was designed to evaluate the effect of Artemisia sieberi essence on the experimental ulcers of cutaneous leishmaniasis on BALB/c mice. This experimental research was performed to determine the effect of various concentrations of Artemisia essence in BALB/c mice previously infected with active Leishmania major promastigote. A total of 50 infected BALB/c mice were randomly divided into 5 groups. Three groups [30 mice] were used in the experimental conditions and the others were assigned as the control groups. The experimental groups received 1%, 3% and 5% of Artemisia, respectively. One of the control groups received ethanol 80% and the other received no treatment. The drug was administered by dropping the liquid on the top lesions, three times daily for maximum of 30 d. Every 10 days the ulcers diameter were measured and sampled for amastigote in all groups. Ulcers diameter changes were determined by statistical tests. After 30 days, diameter of CL lesions increased in 1%, 3% and 5% Artemisia concentrations and the control groups. Ulcers got bigger with the more concentration. Treatments could not reduce the diameter or caused small lesions. In addition, the mice direct smears in microscopic studies were positive. To find the effective concentration and the mechanism of the effectiveness of the drug, further investigations with less concentrates of A. sieberi essence are recommended

Assessment of inter-and intra-observer variability of the la classification for gerd

Los Angeles classification is widely adopted as a means of unifying endoscopic observation for GERD. We assessed the inter- and intra-observer variability of LA classification. Two-hundred fifty-four still images of the lower esophagus taken by an expert endoscopist [RM] were randomly selected and presented to 9 gastroenterologists [2 females, 6 experts, 3 trainees]. They were asked to report the images according to LA classification. After 2 weeks the images were re-ordered and the same people were asked to report them again. Kappa-statistics was calculated for intra- and inter-observer variability. Mean kappa for intra-observer agreement was 0.54 for experts and 0.55 for trainees [p = NS]. Mean intra-observer kappa was greater among females than males [0.70 vs 0.50 respectively, p=0.05]. Mean inter-observer kappa was 0.20 and 0.31 for experts and trainees respectively [p = NS]. Mean inter-observer weighted kappas were 0.25 and 0.07 [p = 0.007] for males and females respectively. Analyzing data for source of the discrepancy showed that the least reproducible reading was GERD-A both for intra- and inter-observer agreement calculations. According to our data, the LA classification, although a major advance in reporting GERD, has a poor to fair reproducibility. There was no difference between experts and trainees in using the LA classification. Females seem to be more consistent in their readings, but have less agreement with others. Despite the inherent short-comings of kappa statistics and the limitation caused by the possible quality of the still images, revision of the LA system seems to be advisable