[Comparing the complications of Gomco and classic methods of circumcision]

There are different surgical procedures for circumcision. Although the classic method is the most common one, it takes more time and causes more pain and complications compared to other methods. The purpose of this study was to compare the complications and the time taken for performing the surgery for Gomco and classic methods of circumcision. This case-control study was performed on 80 neonates referred to the outpatient operating room in Shahid Beheshti hospital for circumcision in 2011 and were divided into two equal groups: one group underwent the classic method and another, the Gomco method. The complications were assessed in two phases: during the surgery by counting bloody gauze pads and one week thereafter using the objective methods, then they were analyzed statistically. The mean age of neonates was 24.8 +/- 12.37 days and no significant difference was seen between two groups. The mean operation duration in the classic method [24.3 +/- 2.5 min] was approximately two times greater than that of the Gomco method [13.3 +/- 2.3 min]. Moreover, the amount of bleeding in the classic method [4.1 +/- 0.6 cc] was over three times greater than that of the Gomco one [1.3 +/- 0.7 cc]. No cases of infection were seen in both groups. Results show that the Gomco method takes less time and causes less pain and fewer complications compared to the classic method and may also be a suitable alternative to the classic method

molecular and antigenic tissue impact of viral infections on liver transplant patients with neonatal hepatitis

Pathogenesis of neonatal hepatitis relates to various underlying causes including viral infections. Both hepatotropic and non-hepatotropic viruses may induce liver failures in infants before birth, during delivery, or shortly after birth. The tissue impact of HCMV, HSV, HBV, HCV, and rotavirus and adenovirus infections was evaluated in studied infants with neonatal hepatitis. The history of viral infections was analyzed in paraffin-embedded biopsy and autopsy tissues of 22 infants with neonatal hepatitis between years 1996 and 2007, retrospectively. The tissue molecular presentation of HBV, HCV, HCMV, HSV, adenovirus, and rotavirus was evaluated by different qualitative simple and nested PCR and RT-PCR protocols. Immunohistochemistry [IHC] method was used for studying the antigenic prevalence of HSV-1, 2; HBV, HCMV and adenovirus infections. Also the laboratory liver indices of all patients with neonatal hepatitis were analyzed. The HBV and HSV genomes were detected in 3 [14%] of 22 infants. The rotavirus and HCV-RNA and also the HCMV-DNA were detected separately in 1 [4%] of 26 paraffin-embedded autopsy and biopsy tissues. The HBV and HSV-1 specific antigens were separately diagnosed in 1 [4%] of 26 neonatal samples by IHC protocols. Also the HSV-2 antigen was seen in 5 [23%] of 22 liver autopsy and biopsy specimens. Co-infections with HCMV, HSV, HBV, HCV, and rotavirus were detected in these infants with hepatitis. Diagnosis of single and mixed molecular and antigenic traces of HCMV, HSV, HBV, HCV and rotavirus underlines the etiologic role of these viruses in clinical pathogenesis of neonatal hepatitis

Spinal Deformity Correction in Duchenne Muscular Dystrophy (DMD): Comparing the Outcome of Two Instrumentation Techniques

STUDY DESIGN: A retrospective matched cohort study. PURPOSE: To compare the results of combined Luque rod-sublaminar wiring (thoracic) and pedicle (lower lumbar) instrumentation (SLW) versus those with pedicle screw fixation (PS) for scoliosis correction in Duchenne muscular dystrophy (DMD). OVERVIEW OF LITERATURE: PS fixation is gaining popularity. Two instrumentation systems were not compared before in a matched cohort of patients. METHODS: Two groups of patients with DMD were matched according to the age at surgery, magnitude of deformity and vital capacity. Indications for surgery included loss of sitting balance, rapid decline of vital capacity and curve progression. In group 1 (22 patients) SLW fixation was used from T2/3 to pelvis or sacrum. In group 2 (18 patients) PS fixation was used from T2/3 to L5. Five patients had all level segmental PS fixations. Minimum follow-up was 2 years (range, 2 to 13 years). Radiographs, lung function tests and subjective/objective assessment were performed at standardized intervals. RESULTS: Mean Cobb angle in group 1 improved from 45.3degrees (range, 26 to 75degrees) to 17.7degrees(range, 0 to 37degrees) and mean pelvic obliquity improved from 14.5degrees (range, 8 to 28degrees) to 5.6degrees (range, 0 to 15degrees). Mean Cobb angle in group 2 improved from 42.8degrees (range, 28 to 80degrees) to 7.3degrees (range, 0 to 20degrees) and mean pelvic obliquity improved from 11.2degrees (range, 7 to 30degrees) to 2.0degrees (range, 0 to 5degrees) (p < 0.05). Mean operating time and blood loss were less in group 2 (p < 0.05). In group 1, the infection rate and instrumentation failure was higher, and subjective/objective outcomes showed no significant difference between the groups. CONCLUSIONS: PS fixation had superior correction and controlled pelvic obliquity without the need for pelvic fixation.

[Effect of donepezil on improvement of consciousness in patients with strock]

Strock is the common cause of death after cardiovascular diseases and cancer. Middle cerebral artery occlusion is the most common disease and because of its high extension in brain, the loss of consciousness is more. Donepezil protected neurologic cells. Effect of donepezil on improvement of consciousness in patients with strock. In this double blind clinical trial study 59 patients were selected according to inclusion criteria and filling out the consent form. They randomly divided to two groups: 28 patients who received donepezil 5mg daily till 4 weeks the 10 mg daily till 3 months [cases group] and 31 patients who received placebo [control group]. Patients' consciousnesses were registered before and after intervention. Change of consciousness was compared between two groups using spss 10. Improvement, no change and deterioration of consciousness was 26.9%, 46.2% and 26.9% in Donepezil group and 3.6%, 32.1% and 64.3% in placebo group, respectively. [p=0.008]. There was a significant difference between two groups, so Donepezil is significantly effective in improvement of consciousness, reduction of mortality and hospitalization in patients with strock

[ case report on tubular duplication of cervical esophagus]

Foregut duplication is commonly found in the posterior mediastinum. About 10-20% of these anomalies are associated with esophageal duplication. It can occur in all parts of esophagus. Although the duplication of cervical esophagus has been previously reported, a majority of it was found in the thoracic oesophagus. Infant esophageal duplication is usually associated to respiratory distress or asymptomatic thoracic mass, casually detected in x-ray. Case Report: In this report the case was a 7 months old infant [7.5 kg] with the chief compliant of respiratory distress, fever and nutritional intolerance. Physical examination of the case showed dehydration, stridor, tachypnea, intercostal retraction and neck stiffness. Plain chest radiogram showed a dual cystic mass in the distal neck region. Neck and chest CT-scan showed cervical cystic lesion disseminated to the posterior mediastinum, probably propagated to the respiratory system. For treatment, cystic lesion attached to the esophagus was partially resected, esophagus was repaired and the remaining mucosa of the cyst was removed, then gastrostomy tube was inserted. Although the cervical esophageal duplication of cysts are rare in infant respiratory distress, they must be considered as one of differential diagnoses of the cervical masses

[Multicentric Castleman Disease : a case report]

Background: multicentric Castleman disease is a rare lymphoproliferative disorder of unknown origin. Castleman disease [CD] also known as angiofollicular lymph node hyperplasia, is a rare lymphoproliferative disorder with poorly understood pathophysiology. The multicentric plasma cell variant is highly associated with infection by human herpesvirus 8 [HHV8], and patients have an increased risk for the development of other HHV8-associated neoplasms, including Kaposi's sarcoma and extranodal B-cell lymphoma. The authors describe a 50-year-old woman that presented with protracted fever with diagnosis of Multicentric Castleman disease

Case: we report a 50-year-old woman that presented with a 5 months history of protracted fever, night sweating, abdominal pain, dyspnea, loss of appetite and weight loss approximately 5 kg. Physical examination was significant for a febrile [39 degree c], ill-appearing in mild distress with a distended and diffusely tender abdomen with moderate splenomegaly, pitting edema on lower limbs and disseminated lymphadenopathy. Despite a comprehensive evaluation, her diagnosis remained elusive for several weeks. Eventually, a lymph node biopsy showed the presence of Multicentric Castleman disease. Due to her relatively poor prognosis and severity of the disease, she was treated with combination chemotherapy consisting of cyclophosphamide, vincristine, and prednisone. She tolerated her therapy well and is currently free of disease at 6 months of follow-up

Conclusions: according to low prevalence of multicentric CD and loss of standard treatment for it and due to the poor prognosis in adults with multicentric CD, the potential for malignancy, we recommend further evaluations [lymph node biopsy] for diagnosis Multicenteric CD in any patients with compatible signs and symptom

[Erect esophageal transit scintigraphy, manometry, and barium swallow in assessment of patients with achalasia before and after balloon dilation]

Achalasia is a motility disorder of unknown etiology. Diagnostic techniques include Barium esophagram, simple and widely available, radionuclide transit/emptying scintigraphy, a low-cost procedures, easy to perform and widely available, well tolerated and require minimum cooperation by patients and esophageal manometry that continues to be used widely in clinical practices, primarily because of its perceived value. Aim of this study was to compare methods of manometry, barium swallow and scintigraphy before and after pneumatic dilation. 17 patients with achalasia of cardia were evaluated both symptomatically and objectively [esophageal manometry, timed barium esophagram, and scintigraphic emptying Index] before treating them with pneumatic dilation and after. The degree of patient symptom