Fever ,weight loss and early satiety due to gastric inflammatorymyofibroblastic tumor; case report and literature review

Gastric inflammatory myofibroblastic tumor [IMT] is a rare tumor with and unpredictable prognosis usually find in young adults. We present an 18-year-old man with gastric IMT. He complained of epigastric pain, intermittent fever and night sweating associated with weight loss since two years ago. Physical examination showed anemic and cachestic features with mild abdominal tenderness in palpitation as well as an abdominal mass in epigastrium. Abdominal CT scan revealed a huge mass that was arising from the stomach. Upper endoscopy revealed a submucosal lesion in fundus of stomach of approximately 8cm. Endoscopic ultrasound showed a large sub-mucosal non homogenous fundal mass with areas of calcification. The patient underwent laparoscopic partial gastrectomy. Histopathologyand immunohistochemistryevaluation revealed an IMT

effect of mind education by imagery on depression of elders

Introduction: One of the most common psychiatric disorders in the twentieth century especially in elderly is depressive disorder. Several studies indicated that the rate of the depression at the nursing homes was 43-86%, impaired quality of life, and increased the risk of suicide and health care cost are the consequences

The present study intended to determine the effectiveness of general guided imagery technique on mental elderly depression

Methods: A quasi-experimental study was conducted with 39 elders living at nursing home who were randomly allocated in two groups of intervention and control [experimental group: 20, control group: 19]

The general guided imagery technique was designed to reduce depression, and was carried out during 8 sessions each of which lasted 30 to 45 minute for 8 weeks. Correspondingly, The Control group received routine services. Additionally, the data collection tools were the questionnaire, the demographic and the geriatric depression scale. To analyze the collected data, Chi-square, Student's t-test and paired t-test were used

Results: Findings of this study showed a significant difference between pre and post intervention, where the elderly depression mean score in experimental group changed from 9.65 to 5.40 [P<0.000] but no significant difference was observed in the control group [P>0.262]. Conclusion: Considering the result of this study, it can be suggested that general guided imagery technique is effective on the reduction of elderly depression levels. Therefore, it is highly recommended to utilize this technique by clinical nurses, nurse managers and nursing students

Neuropathological changes in brain cortex and hippocampus in a rat model of Alzheimer's disease

Alzheimer's disease [AD] is a neurodegenerative disorder with progressive loss of cognitive abilities and memory loss. The aim of this study was to compare neuropathological changes in hippocampus and brain cortex in a rat model of AD. Adult male Albino Wistar rats [weighing 250-300 g] were used for behavioral and histopathological studies. The rats were randomly assigned to three groups: control, sham and beta-amyloid [Abeta] injection. For behavioral analysis, Y-maze and shuttle box were used, respectively at 14 and 16 days post-lesion. For histological studies, Nissl, modified Bielschowsky and modified Congo red staining were performed. The lesion was induced by injection of 4 microL of Abeta [1-40] into the hippocampal fissure. In the present study, Abeta [1-40] injection into hippocampus could decrease the behavioral indexes and the number of CA1 neurons in hippocampus. Abeta injection CA1 caused Abeta deposition in the hippocampus and less than in cortex. We observed the loss of neurons in the hippocampus and cerebral cortex and certain subcortical regions. Y-maze test and single-trial passive avoidance test showed reduced memory retention in AD group. We found a significant decreased acquisition of passive avoidance and alternation behavior responses in AD group compared to control and sham group [P<0.0001]. Compacted amyloid cores were present in the cerebral cortex, hippocampus and white matter, whereas, scattered amyloid cores were seen in cortex and hippocampus of AD group. Also, reduced neuronal density was indicated in AD grouper ovariectomy

Cord compression due to extramedullary hematopoiesis in two patients of beta -thalassemia intermedia

Thalassemia is the most important hemoglobinopathy in Khuzestan province. Thalassemia intermedia [TI] is a genetically heterogenous disease and can result from many different genetic lesions. We report two cases of TI-EMH caused by two separate mechanism and their successful management. Magnetic Resonance Imaging [MRI] is the best diagnostic method in these cases. Management can be done via: Transfusion therapy, Radiotherapy, Hydroxyurea [HU], and Surgery. A 17 years old girl with beta-TI previously asymptomatic presented with back pain and leg weakness which started one month ago. The other patient was 25 years old man referred to hospital with back pain, paresthesia, urine frequency and impairment of gait. In the first case the cause of cord compression was the osseous expansion while in the second patient it was related to soft tissue EMH. First patient was successfully treated with low dose radiotherapy and HU. Radiotherapy was initiated with 200cGY fractions to a total dose of 1600cGY and HU 10mg/kg/day. At the end of radiotherapy, the patient was ambulatory with mild residual weakness. She was regularly followed for two years; at present she is active and asymptomatic. The second patient was successfully treated with low-dose radiotherapy and HU. Radiotherapy was started in 200cGY fractions to a total dose of 1600cGY and HU was given at 10mg/kg/day. At the end of radiotherapy the patient was ambulatory with mild residual weakness. He was regularly followed for six months. At his last visit, he was able to walk and climb stair without any assistance. His neurological examination was much better than before. The most common site of spinal epidural extramedullary hematopoiesis is the posterior aspect in the thoracic spine. EMH can be prevented by regular transfusion therapy which corrects anemia and thereby abolishes the stimulus for EMH. Surgical decompression is the method of choice for the management of EMH because histological diagnosis can be established and immediate decompression of the mass can be achieved. This is especially important to decompress the spinal cord quickly in patients with epidural mass caused by EMH. The disadvantages of surgical intervention include risk of excessive bleeding due to high vascularity of the mass and higher incidence of recurrence. In areas where thalassemia is prevalent, EMH should be considered in the differential diagnosis of patients who have chronic anemia with an intrathoracic mediastinal mass

Clinical differentiation between resistant asthma and chronic bronchiolitis: testing a practical approach

Intractable asthma is a challenging clinical problem. This study was conducted to determine whether a subset of patients with Intractable asthma may be misdiagnosed and have a form of bronchiolitis instead and also to determine the effectiveness of macrolide therapy in these patients. Seventy six patients with Intractable asthma were re-treated with recommended maximal doses of oral prednisolone for 5 days, beclomethasone, cromolyn sodium, salbutamol and ipratropium bromide for 30 days. Thirty five patients were considered as unresponsive and constituted the study group. They underwent high-resolution CT [HRCT] scan following which they were offered with video-assisted thoracoscopic surgical biopsy. Group 1 [n=27] refused biopsy and each was treated with macrolide therapy, while Group 2 [n=8] underwent biopsy, and then received macrolide therapy. The patients were treated and followed for three months. The study group consisted of 27 patients, with a mean age of 46.9 +/- 11.1 years. The mean duration of time between the onset of symptoms and the start of this study was 8.1 years. In group 2, no patient had pathologic findings of asthma, and 7/8 had a form of bronchiolitis. There was significant improvement in dyspnea, cough and pulmonary function indices at the end of the 3-month in both groups [p<0.001]. Our results suggest that patients with Intractable asthma could be misdiagnosed and some of them have some forms of chronic bronchiolitis. We believe that any patient who does not respond to standard treatments for Intractable asthma should be evaluated with expiratory HRCT; those with significant air trapping should be considered for a course of macrolide therapy or biopsy for better identification of the underlying disease