Central nervous system and limb embolism concurrence due to atrial myxoma: a case report

Cardiac myxomas are the most common cardiac tumors with diverse nonspecific clinical manifestations. A 78-year-old man presented to the emergency department with complaints of pain and coldness of the left lower extremity. The left femoral artery pulse was detected, while the pulses of the left popliteal, dorsalis pedis, and posterior tibialis arteries were absent. No blood inflow was detected in the superficial and deep femoral, popliteal, and anterior and posterior tibialis arteries. Thrombectomy was performed, and a fatty-like mass from the bifurcation of the common femoral artery and a thrombotic mass from the proximal portion of the superficial and deep femoral arteries were removed. The pulsatile inflow and palpable pulses of the left femoral, popliteal, dorsalis pedis, and posterior tibialis arteries were restored after surgery. The histological findings of the embolus were suggestive of a cardiac myxoma. The patient's consciousness and lower limb blood flow improved gradually. He was discharged from the hospital with full awareness and improved lower extremity muscle function 2 weeks after surgery

[Sensitivity and specificity of endoscopy in diagnosis for Barrett's esophagus]

Lack of precise diagnostic criteria and sufficient findings in support of biopsy sampling during upper gastrointestinal endoscopy is one of the special challenge in endoscopy assessment in Barrett's esophagus. The aim of this study was to evaluate the mucosa in the distal esophagus tissues through a biopsy during upper gastrointestinal endoscopy in gastroesophogeal reflux disease patients whose symptoms don't improve or only partially resolve with treatment. A cross-sectional study was done in patients with gastroesophogeal reflux disease medically resistant to treatment. The patients were assessed by gastroenterology department in Sina Hospital, Tehran, Iran, since September 2012 to September 2013. Patients with coagulopathy, esophageal varicose, esophageal cancer, earlier detection of developing Barrett's esophagus, history of irritable bowel syndrome, psychological disorders and using of nonsteroidal anti-inflammatory drugs [NSAIDs] such as aspirin, were excluded. Esophageal squamous epithelium and cylindrical tissue of stomach was carefully checked by endoscope. Then 2 to 4 biopsy of the Z-line above the gastroesophageal mucosa were obtained. One hundred and fifty three patients included 78 men [511/6] and 75 females [49%] with a mean age of 47.92 +/- 17.57 years participated in the study. The mean of body mass index of patients was 25.05 +/- 4.17 kg/m[2] and body mass index in 45.8% of the patients more than 230 kg/m[2]. Biopsy specimens were taken in 31 cases were not enough for histological examination. In other patients, 25 cases [20.5%] were normal and 97 cases [79.5%] had the following pathological diagnosis: mild esophagitis [49 cases; 40.2%], moderate esophagitis [24 cases; 19.7%], severe esophagitis [14 cases; 11.5%], Barrett's esophagus [8 cases, 6.5%], fungal esophagitis [1 cases, 0.8%], and eosinophilic esophagitis [1 cases; 0.8%]. 117 patients [76.5%] had H. pylori infection. Sensitivity and specifity of endoscopy for detection of Barrett's esophagus during upper gastrointestinal endoscopy were 100% and 84.13% [CI 95%:78.53-89.09%], respectively. Our data showed that doing of accurate and adequate biopsy samples from lesions in upper GI endoscopy can be helpful in the diagnosis of Barrett's esophagus

Clinical outcomes of total hip arthroplasty in patients with ankylosed Hip

Hip ankylosis includes the limitation of hip motion and hip arthroplasty is the recommended treatment. This study aimed to evaluate the clinical and radiographic outcomes in the treatment of ankylosis hip joint by the Harris Hip Score [HHS]. This interventional study was performed on patients with ankylosis in one or both hip joints, who were referred to Sina Hospital, Tehran, Iran from 2011-13. Electromyogram and nerve conduction studies were taken from the hip abductor muscles before surgery and HHS was calculated. Type of surgery and prosthesis, osteotomy required for the neck and trochanteric region of the femur, periprosthetic fracture and the need to restore acetabular were studied in the patients. Postoperative complications such as infection and dislocation at 3, 6 and 12 months after surgery were examined and then the HHS was calculated. Seventy-seven patients [42 m/35 f] with a mean age of 36.71 +/- 11.78 years underwent total hip arthroplasty. Most causes of hip joint ankylosis in the patients were elderly osteoarthritis [20 cases] and avascular necrosis [13 cases]. Electromyogram and nerve conduction studies showed high and low velocity conduction in 12 and 65 patients, respectively. We used the posterior approach in 55 patients [71.4%] and lateral approach in 22 patients [28.6%]. Periprosthetic fracture occurred in two patients and 12 patients needed acetabular reconstruction. Standard prosthesis was used in 83.1% of patients. Six patients in month 6 and two patients in month 12 were excluded from the study due to surgery complications. The HHS mean of patients before surgery was 48.53 +/- 6.28 and it progressed to 88.22 +/- 3.78 in the month 12 [P<0.001]. Total hip arthroplasty for patients with ankylosed hip can improve the range of joint motion, especially in the long-term follow-up. However, good results should be considered in the absence of pre- and post-operative complications

Rhabdomyosarcoma with skin metastasis: report of a case

Rhabdomyosarcomas are the most common soft tissue sarcoma in adult and children that accompany with skeletal muscle differentiation. Skin metastasis of rhabdomyosarcomas is unusual and has only been sporadically reported in literature. In this paper we present a case of skin metastasis of rhabdomyosarcoma in an 8-year-old girl that has treated with chemotherapy

[Management of acute radial or ulnar artery injury in hospital emergency department]

Severe arterial injuries in the hand can be hazardous to the limbs and even life- threatening. The aim of this study was to investigate the management methods in the patients with acute injuries of the ulnar or radial artery in the emergency department. Material and This cross-sectional prospective study was conducted in the emergency department of Sina Hospital in Tehran, from 2012 to 2013. Stable vital signs, wrist and forearm laceration with jumper or active bleeding, radial or ulnar artery injury; one or both were among our inclusion criteria. Vital signs, level of consciousness, coincident injuries were assessed and physical examination was performed in all patients. We recorded time of patient arrival, primary and secondary treatment, and consultation and follow up visits in emergency department or ward. 50 patients [3 females and 47 males] with a mean age of 30.34y +/- 9.69y were enrolled. The first step was to examine and pack up bleeding. The most common injury was due to sharp instruments [84%] and the most common injured artery was radial artery [68%].The mean duration of the first treatment was 1.24 +/- 0.93 min. 37 patients [74%] were treated by ligation in the emergency room and the remaining 13 patients [26%] were sent to the operating room for repair and vascular anastomosis by our vascular surgeon. Mean values of duration for ligation were 16.72 +/- 13.83 min and 117.76 +/- 114 min in emergency medicine and vascular surgery groups, respectively that showed a significant difference between the two groups [p= 0.0001]. The overall duration of hospitalization for the patients was 69.04 +/- 82.74 hour [5- 311 hours]. Conclusions: We can conclude that the radial or ulnar artery ligation considering its indications or contraindications, in emergency room can play an important role in the recovery of patient's hemodynamic status and speed up of the next step of patient's treatment

Medical malpractice frequency in the psychiatric field, in medical council of Iran, from 2001 to 2010: a brief report

Identify the causes of complaints and contributing factors may reduce medical litigation. The aim of this study was to assess the cases of complaints in the field of psychiatric. This study was done in retrospective cross-sectional study method. We investigated 27 cases of medical malpractice in the field of psychiatry that registered in higher disciplinary board of the Medical Council of Iran, from 2001 to 2010. We calculated the absolute and relative frequency of variables after collecting all data and calculated the difference between malpractice and exculpation cases based on physicians profile by Pearson's chi-squared test and Fisher's exact test. P< 0.05 was considered as statistically significant difference. The 24 people who died and their families protested against psychiatrist were enrolled in this study. Demographic information and other characteristics of the cases were collected. All participants had been men. Seventeen of 24 cases [70.84%] were in 30-50 year old group and seven of 24 cases [29.16%] were in > 50 year old group. The most common types of negligence were related to disregarding of governmental provisions [40%]. The age, expertise and place of medical activities were variables that different significantly between negligence and non-negligence groups [P< 0.05]. The results of the study showed eight cases of 24 cases [33%] in the lower board, nine cases of 24 cases [37.5%] in the appeals board and eight cases of 24 cases [33%] in the higher disciplinary board were acquitted. Based on the study findings, it appears that age, expertise and practice location are factors that can be effective in reducing malpractice in psychiatry

[Treatment of labial adhesion with topical estrogen and correlation with serum estradiol level]

Serum estradiol level is a controversial prognostic factor in the outcome of labial adhesion. The aim of this study was to evaluate serum estradiol levels and topical estrogen response in patients with labial adhesion. A prospective interventional study was conducted among girls with labial adhesion that referred to Pediatrics clinic in Taleghani University Hospital, Gorgan city, Iran in 2011. One hundred patients entered the study. The diagnosis was conducted by clinical examination of vestibule area. Inclusion criteria were, three months to eight years old prepuberty girls, no ambiguous genitalia, lack of vulvovaginitis symptoms, labial adhesion more than twenty five percent, no history of previous topical estrogen treatment since two weeks ago and previous incomplete treatment. The patients who did not use proper amount and duration of drug and also with adverse drug reactions during treatment period were excluded from the study. The maximum frequency of labial adhesion was in the group of less than one year old. The minimum frequency of labial adhesion was in the 7-8 years old group. Eighty six patients had complete or partial remission. No evidence of an improvement was observed in fourteen children. Severity of adhesions did not worsen in our patients. Serum estradiol levels were lower in patients who had a positive response to treatment. There were significant differences in serum estradiol levels between full or relative improvement with no improvement groups [P=0.044]. Findings of this study showed that the labial adhesion patients with low serum estradiol level had better treatment response after using topical estrogen.

[Percutaneous endoscopic gastrostomy technique: the outcome and complications]

Background: Percutaneous endoscopic gastrostomy [PEG] is one of the ways to non-oral feeding in patients with dysphagia caused by conditions such as stroke, oropharyngeal malignancy and motor neuron disease. The aim of study was assessment of early outcome of PEG in hospitalized patients according to clinical situation and underlying disease

Methods: This study was cross- sectional and prospective. Sixty five patients were included with PEG from April 2011 to July 2012, at Sina University Hospital, Tehran, Iran. Tube function, feeding, and patients' symptoms were assessed and patients were followed six month at least to one year after procedure .The follow up of patients were stopped if the patient died or removal of tube

Results: Sixty five patients [33 men, 32 women] enrolled in this study. The mean age of patients was 57.45+/-16.83 years [19-94 years]. Head trauma and postoperative thoracic surgery were in 15 [23.1%] and 4 [6.2%] cases. 36 of patients [55.39%] had no symptoms. The complications include lickage [11 cases], stenosis [9 cases], cellulitis [7 cases], and PEG separation [2 cases]. A total of 29 patients were complicated and 21 patients [72%] of them complicated 2 -5 months after PEG. No statistical significant differences between two sexes in PEG complication. 27 patients [41%] died that have no relation to complications of PEG

Conclusion: Finally, the study showed the PEG is a safe method to enteral nutrition. The advantages of this method include its simplicity, no need to general anesthesia and low rate of complications especially in inpatient under the supervision of medical staff. Therefore it can be used as a favorable method

[Correlation between lumbar vertebral instability and severe degenerative spondylolisthesis]

Severe spondylolisthesis is related to high degenerative changes in vertebral spine. Degenerative spondylolisthesis often is seen with high-sacral slope. This study was conducted to investigate the relationship between high degenerative spondylolisthesis and sacral slope. A cross-sectional prospective study was done in patients with low back pain in Shafa Yahyaian and Sina University Hospitals in Tehran, in 18 months [April 2010-October 2011]. Intermittent or continuous low back pain for three months and history of two disable low back pain attacks since one year ago were inclusion criteria. Pregnant patients were excluded. Lumbar vertebra displacement to vertebra body size ratio was calculated in dynamic mode. The ratio higher than 8% was considered as a lumbar instability. Rotation angle more than 11 Degree was considered abnormal. In this study, 52 patients [30 men, 22 women] with 38.35 +/- 9.49 years old were enrolled. Mean body mass index was 23.01 +/- 4.59 kg/m[2]. Thirty cases had abnormal vertebral displacement. Angulation of the disc space more than 11 degrees was seen in 20 patients. No statistically significant difference in pelvic index between normal and abnormal lumbar vertebra displacement [P=0.443]. The mean pelvic index in normal and abnormal angulation groups were 55.97 Degree and 53.58 Degree, respectively; the difference was not statistically significant [P=0.556]. The results of the study showed disc degeneration had no association with sacral slope. High sacral slope can intensify spondylolisthesis but does not affect the incidence of degenerative spondylolisthesis. Additional research is required to find the other causes of degenerative spondylolisthesis

[Levetiracetam and lamotrigine in old aged onset of epilepsy: a randomized double-blind clinical trial]

Choosing the right drug with the least side effects and highest effectiveness for the control of seizures in the elderly is important. The aim of this study was compare the efficacy of lamotrigine and levetiracetam in the management of epilepsy in the elderly. This study was performed as a double-blind randomized clinical trial in patients that referred to the neurologic clinic at Sina University Hospital, Tehran, Iran in 2012. The patients over sixty years old with a diagnosis of epilepsy were selected. They had one seizure in year at least and one attack in the last 6 months. First, the patients divided to two groups; Group one were treated with lamotrigine, 25 mg per day and group two were treated with levetiracetam, 250 mg per day for 24 weeks. In the absence of drug complications, the dose was increased to the maximum dose listed in the treatment protocol. Second the patients were followed in number of attacks, abnormalities in laboratory data and side effects of drug in 2, 4, 8, 12 and 20 weeks. The collecting data of the study were analyzed using descriptive and analytical statistics methods. Forty nine cases, 28 males and 21 females in lamotrigine group and 46 cases in levetiracetam group, 27 males and 19 females participated in the final analysis. Mean age of patients was 72.40 +/- 5.87 [63-85]. Drug side effects were observed in 57 cases, 26 cases of lamotrigine group and 31 cases of levetiracetam group. Seizure frequency showed a declining trend in both groups but in lamotrigine group more than levetiracetam group in last week [P = 0.039]. The findings of the study showed lamotrigine and levetiracetam were effective in management of epilepsy in the elderly. Levetiracetam has a higher seizure-free effect than lamotrigine but lamotrigine is better tolerated than levetiracetam

[Greater occipital nerve block by bupivacaine/methyl prednisolone vs. bupivacaine/normal saline in medication overuse headache]

Medication overuse headaches [MOH] include headaches that last more than 15 days a month and usually occur after long-term use of analgesic. Most methods of medical treatment are ineffective. In some studies, great occipital nerve block is used to treat the headaches. This double-blind experimental study was performed in adult patients with MOH who attended Sina Hospital in Tehran from June 2009 to June 2011. Greater occipital nerve [GON] block was done in the two groups of patients by administering a combination of 3 ml of 0.5% bupivacaine and 2 ml of 5% saline or 3 ml of 0.5% bupivacaine and 80 mg of methyl prednisolone. We evaluated headache severity by Visual analog scale [VAS] and recorded days without headache. If patients were taking pain medications, preventive medications were given as usual before and after the injection. Student's t-test was performed for statistical analysis and a P<0.05 was considered significant. Overall, 13 male and 19 female patients with a mean age of 39.88 +/- 8.76 years participated in the study. The mean reduction in headache severity one hour after injection was 5.56 +/- 1.03 and 4.63 +/- 1.92 in the first and second groups, respectively. Average days without headache one month after injection were 8.75 and 4.75 days in the first and second groups, respectively. There were no significant differences between the two groups. Both methods seem to be effective in medication overuse headaches treatment. This finding is important as non-responders to conventional methods will otherwise have a decreased quality of life

[Prevalence of colorectal polyps among women with ovarian and endometrial cancers admitted in Firoozgar, Akbarabadi and Rasol Akram Hospitals during 2010- 2011: a brief report]

Patients with endometrial or ovarian cancer have an increased risk for breast or colon cancer. The aim of this study was to assess the individual and age-related characteristics of patients with a combination of these malignancies. In this retrospective descriptive study, we reviewed the medical records of 100 patients admitted for endometrial or ovarian cancer in Rasol Akram, Akbarabadi and Firozgar educational Hospitals in Tehran, Iran, during 2010- 2011. Colon polyps were evaluated by immunohistochemistry assay. The mean age, weight and BMI of the patients were 50.21, 65.9 and 26.07, respectively. Among 100 cases participating in this study, five [5%] patients had colon polyps. All the five cases with colon polyp had positive familial histories of ovarian cancer. With considering the low prevalence of colorectal polyps among women with ovarian and endometrial cancers, patient's follow-up for screening test is not recommended