[Multiple pseudotumors of the liver associated with adenocarcinoma of the colon: a case report]

Hepatic inflammatory pseudotumor [IPT] is a rare non-neoplastic process of unknown etiology, generally following a benign inflammatory condition. It is often mistaken as an either primary or metastatic malignancy in imaging studies. We report a 48 year-old female with numerous target lesions [2-4 cm] seen on high resolution ultrasound, spiral CT scan, and MRI in all liver lobes compatible with metastasis. Guided biopsies of the lesions were performed twice, but the pathologies showed no evidence of malignancy. Colonoscopy revealed adenocarcinoma of the colon. This case highlights liver pseudotumor in the differential diagnosis of hepatic tumoral lesions

[Survey of effective factors on nursing graduated motivation to participate in job training programs in affiliated baqiyatallah university hospitals]

One of the useful and cost-saving methods in promotion and coordination of nursing profession with improvement resulted from technology social and medical science is the in- service training, to participate of medical centers staff in the course depend on a variety of motivational factors. This study intend to determine the factors related to nurses motivation in participating the program of in service training. In a descriptive study, 229 nurses chose their motivation factors in participation in the in service training through completion of standard 27-qusestion-questionnaire with the likert scale about domains of personal, organizational, professional factors and factors related to periodical programming. About factors involved in nurses motivation for participating in the in service training, they select professional [85.2%], personal [79%], programming [30.6%] and organizational [30.6%] factors for participating in the in service training. The significant relationship were observed between organizational factors and sex [P<0.001] and workplace [P<0.005], between professional factors and the type of employment [p<0.004], and between program factors and sex [P<0.004], and type of employment nurses [p<0.002]. Most of motivation factors to participation of nurses in the in service training is personal and professional factors. Therefore it is necessary that health care organizations consider other organizational related factors. This study is the first study in military hospitals therefore the results could be useful for other military medical centers

Flutamide-induced hepatotoxicity: a case report

Flutamide is a non-steroidal antiandrogen commonly used in the treatment of prostate cancer. Severe hepatotoxicity occurs in few patients, yet may be fatal. To date, none of the reported cases of fiutamide hepatotoxicity has demonstrated thrombocytopenia and chronic liver disease. We report the case of a 55-year-old male with prostatic adenocarcinoma who developed liver failure after six months of fiutamide therapy. The patient was referred with complaints of drowsiness, weakness, fatigue, and nausea in addition to jaundice, ascites, leg edema, splenomegaly, and bilateral pleural effusion. Laboratory findings included thrombocytopenia, hypoalbuminemia, and prolonged prothrombin time, with elevated aminotransferase and bilirubin. Abdominopelvic spiral computed tomography [CT] scan showed ascites and bilateral plural effusion. He discontinued flutamide and ursodeoxycholic acid [UDCA] was started. The patient completely recovered within four months. This was a rare case of flutamide-induced hepatotoxicity in a patient who referred with signs of advanced liver disease and thrombocytopenia. It appeared that UDCA was an effective therapy for fiutamide hepatotoxicity

Effectiveness of two H9N2 low pathogenic avian influenza conventional inactivated oil emulsion vaccines on H9N2 viral replication and shedding in broiler chickens

The objective of this study was to compare the effect of two conventional H9N2 avian influenza [AI] vaccines on replication and shedding of the H9N2 AI virus in broiler chickens. These inactivated oil emulsion vaccines contain either a UAE or an Iranian H9N2 AI isolate. One hundred and fifty one-day-old commercial broiler chickens were randomly divided into six groups. The birds, except for the control group [group 4], were challenged with a low pathogenic A/Chicken/Iran/SH-110/99[H9N2] virus isolate. Birds in groups 1 and 5 were vaccinated with an Iranian AI vaccine and groups 2 and 6 with an UAE vaccine type. Birds in groups 5 and 6 were also vaccinated with an H120 strain of infectious bronchitis live vaccine. On days 3, 7, 11, and 15 post inoculations [PI] the trachea, lungs, kidneys and faeces were collected for molecular detection and quantitation of the H9N2 AI virus using TaqMan real time PCR assay. The results showed that frequency of virus recovery and viral titration was generally higher for unvaccinated challenged birds [group 3] on all days PI. No virus was detected in the chicks of group 1. The virus was detected in some cases in the tracheas and lungs of chicks in groups 2, 5 and 6. However, there was no statistically significant difference in viral replication in the trachea and lungs between chicks vaccinated with the UAE and Iranian type vaccines. The most frequent detection of the virus was in the kidneys in comparison with the other samples. The viral titer in the kidneys of unvaccinated challenged birds [group 3] on day 3, 7, 11 and 15 PI was higher than those of the same organs in the vaccinated challenged birds [groups 1, 2]. The highest titer of the virus was observed in the faeces of unvaccinated challenged and the chicks vaccinated with the IB and UAE type vaccine [group 6] on day 7 PI. There was a statistically significant difference in viral shedding between groups [1 and 3], [2 and 3] and [5 and 6] [P=0.008]. Infectious bronchitis live vaccine could increase the AI virus propagation and shedding in co-infected groups [groups 5 and 6]. Altogether, both AI H9N2 vaccines could effectively reduce viral replication and shedding in broiler chicken, however, in order to achieve efficient control of the disease, vaccination should be accompanied with other preventive measurements including biosecurity practices

[Extra-intestinal symptoms and their relationship to psychological symptoms in patients with irritable bowel syndrome]

Irritable bowel syndrome [IBS] is one of the most common functional gastrointestinal disorders. A significant number of IBS patients have extra-intestinal symptoms [EIS], but the etiology of co-morbidity of IBS with these symptoms is unclear. The aim of this study was to evaluate the relationship of EIS with psychological symptoms in IBS patients. This multicenter, cross-sectional study was conducted on 18 to 65 year old IBS patients [Rome III criteria] referred to four gastroenterology outpatient clinics in the city of Isfahan from 2008-2009. Patients completed the IBS symptom severity scale, EIS severity scale, and anxiety and depression scale. Linear regression analysis was applied to evaluate the relationship of psychological symptoms with EIS, controlling for other variables. During the study period, 142 IBS patients [mean age=30.9 +/- .1 years, 81.7% female] were included. ESI score was significantly correlated to IBS severity score [r=0.534], anxiety [r=0.551] and depression scores [r=0.407]; P<0.001. With linear regression analysis, female gender [P=0.028], IBS severity [P<0.001], and severity of anxiety [P=0.001] were related to ESI scores. According to these results, psychological symptoms are associated with EIS in IBS patients, though prospective studies are needed to evaluate a causative association. Thus, gastroenterologists must pay attention to the association of psychological symptoms with EIS in the treatment of IBS patients and refer them for appropriate therapies

[ efficacy of pre-hospital care in traumatic patients referred to emergency ward of "Sina Hospital" between September 2003 and September 2004]

The accuracy of the pre-hospital care has not been evaluated in Iran so that the purpose of the present study was to evaluate the efficacy of the pre-hospital care performed by Tehran Emergency Service in traumatic patients referred to "Sina Hospital". This prospective study was conducted on traumatic patients referred to emergency department of "Sina hospital" by Tehran Emergency Service from September 2003 to September 2004. The accuracy of the pre-hospital care performed by Tehran Emergency technicians, regarding the patients' general condition was evaluated. The on-call physicians in emergency department of "Sina hospital" were responsible for gathering the data and filling the questionnaires based on their observation and the EMS forms. 994 patients were enrolled in the study. Wound bandage and homeostasis were done correctly in 80% of the cases. Splint was applied correctly in 50% of the patients, while other therapeutic procedures such as collar and spinal bed were not performed among 80% of the cases. IV-line was obtained in 91.2% of the patients, while serum infusion was initiated in only 20% of patients. It is recommended to compile evidence-based protocols for the pre-hospital procedures and train the emergency technicians to follow the rules, in order to improve the efficacy and the accuracy of the pre-hospital care. According to the principal changes recently made in the quality and quantity of the care offered by Iran's Emergency Service, it is necessary to perform a new study to evaluate the present condition and compare the results of these, qualitative and quantitative changes with the current study

Accuracy of spiral CT in non-traumatic acute abdominal pain in Sina University Hospital

Acute abdominal pain is a common complaint in an emergency setting. An immediate and precise diagnosis is necessary for reducing morbidity and mortality. Several studies have reported that CT scan increases diagnostic accuracy for patients with acute abdominal pain. This study was designed to evaluate the sensitivity, specificity and accuracy of spiral CT scan compared to that of abdominal ultrasound and plain radiography. We assessed the data of 91 consecutive patients, including 45 males and 46 females, ranging in age from 8 to 84 years [mean age 52.38 years] presenting to the emergency department of Sina Hospital, Tehran, Iran, with acute non-traumatic abdominal pain during the years 2003-2005. All patients underwent spiral CT scanning; in addition, sonography and plain radiography were performed for 66 and 64 of the patients, respectively. The sensitivity, specificity and accuracy were calculated and compared, based on the final diagnosis, which was established with surgical, pathologic, and clinical follow-up. The data was analyzed by SPSS 13.0 software. Among the 91 patients examined, CT scan was reported to be normal in 15 patients [16.5%]. The most common CT findings were aortic aneurysm [12.1%], pancreatitis [9.9%], ovarian cyst [7.7%], intestinal distension [7.7%], and hepatic cyst [7.7%]. The overall sensitivity, specificity, and accuracy of unenhanced spiral CT were 92.2%, 92.86%, and 92.3%, respectively, whereas those of plain radiography were 13.2%, 72.7%, and 23.4%, respectively, and ultrasound 73.2%, 90%, and 75.7%, respectively. This study suggests that plain radiography is an insensitive technique in the evaluation of nontraumatic acute abdominal pain presenting in the emergency department. Unenhanced spiral CT is accurate for adult patients with nontraumatic acute adominal pain and should be considered as an alternative to radiography as the initial imaging modality