The association between the volume of the gallbladder based on sonographic findings and demographical data in the PERSIAN Guilan cohort study (PGCS).

BACKGROUND: Ultrasound is an important method to determine the volume of the gallbladder and check its structure. Considering the variation in the size and volume of the gallbladder in disease and physiological conditions, determining the volume of the gallbladder is clinically valuable. This study was carried out to evaluate the gallbladder volume and its association with patients' demographic data in the Prospective Epidemiological Research Studies of Iranian Adults (PERSIAN) Guilan cohort study (PGCS) population. METHODS: In this cross-sectional study, 957 individuals aged 35-70 participated in determining the gallbladder volume by a radiologist based on the ultrasound method. The demographical data were collected using a questionnaire. After fasting for 12 h, the ultrasound was performed with an Ultrasonic device (Sonix SP series) with a 3.5 to 5 MHz probe. RESULTS: The total frequency of gallbladder lesions was 2.2%. The results showed a significant association between marriage and gender with the presence or absence of lesions in the studied participants (P < 0.05). Also, significant differences were reported between the volume of gallbladder and gender, body mass index (BMI), social and economic status (SES), metabolic equivalent of task (MET), history of cardiovascular disease (CVD), and hypertension (P < 0.05). The results of a linear regression represented a significant association between gender, BMI, MET, and CVD and the mean volume of the gallbladder (P < 0.05). However, there was no significant association between the presence or absence of a lesion and the individuals' average gallbladder volume (P > 0.05). CONCLUSION: According to our results, gender, BMI, MET, and CVD were significantly associated with gallbladder volume.

Can indirect magnetic resonance arthrography be a good alternative to magnetic resonance imaging in diagnosing glenoid labrum lesions?: a prospective study.

BACKGROUND: This study was designed to evaluate and compare the diagnostic value of magnetic resonance imaging (MRI) and indirect magnetic resonance arthrography (I-MRA) imaging with those of arthroscopy and each other. METHODS: This descriptive-analytical study was conducted in 2020. All patients who tested positive for labrum lesions during that year were included in the study. The patients underwent conservative treatment for 6 weeks. In the event of no response to conservative treatment, MRI and I-MRA imaging were conducted, and the patients underwent arthroscopy to determine their ultimate diagnosis and treatment plan. Imaging results were assessed at a 1-week interval by an experienced musculoskeletal radiologist. Image interpretation results and arthroscopy were recorded in the data collection form. RESULTS: Overall, 35 patients comprised the study. Based on the kappa coefficient, the results indicate that the results of both imaging methods are in agreement with the arthroscopic findings, but the I-MRA consensus rate is higher than that of MRI (0.612±0.157 and 0.749±0.101 vs. 0.449±0.160 and 0.603±0.113). The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of MRI in detecting labrum tears were 77.77%, 75.00%, 91.30%, 50.00%, and 77.14%, respectively, and those of I-MRA were 88.88%, 75.00%, 92.30%, 66.66%, and 85.71%. CONCLUSIONS: Here, I-MRA showed higher diagnostic value than MRI for labral tears. Therefore, it is recommended that I-MRA be used instead of MRI if there is an indication for potential labrum lesions.

Imaging Accuracy in Diagnosis of Different Focal Liver Lesions: A Retrospective Study in North of Iran.

INTRODUCTION: Focal liver lesions (FLLs) are incidentally detected masses found in daily abdominal imaging which are necessary to be characterized, because of the potential of being malignant. There are several imaging methods, such as ultrasonography (US), computed tomography (CT scan), and contrast enhanced magnetic resonance imaging (MRI). Here, we evaluate and compare the diagnostic accuracy (i.e., sensitivity and specificity) of these imaging methods for the diagnosis of FLLs. MATERIAL AND METHODS: In this retrospective study, patients with focal liver lesions included and based on the gastroenterologist decision, in 79 patients different imaging methods were used to determine the nature of FLLs: the US, CT scan, and MRI. At the next step, fine-needle aspiration biopsy (FNA) was performed in all cases, and the results about the true nature of FLLs compared with different imaging results. The chi-square test and McNemar test were used. RESULTS: Ultrasound diagnosis of benign and malignant was obtained with 82% diagnosis accuracy, 100% sensitivity, 71.4% specificity, 100% negative predictive value, and 69.2% positive predictive value (PPV) compared with the biopsy. Also, the results of benign and malignant masses in CT scan were obtained with diagnostic accuracy of 95%, 100% sensitivity, 80% specificity, 93.9% positive predictive value, and 100% negative predictive value. MRI performed only in 2 cases with similar results to pathology. CONCLUSION: It seems that CT scan is more appropriate and useful in the diagnosis of hepatic masses due to its higher diagnostic accuracy than the ultrasound.

Two-Dimensional Change in the Cystic Defects after Decompression and Enucleation of Jaw Cysts - A Comparative Study.

Introduction: To compare the treatment methods of enucleation and decompression with regards to reduction of the dimension of the cystic defect with the aid of a software program. Materials and Methods: Thirty patients with regular controls of 3, 6, and 12 months treated between January 1, 2013, and January 1, 2021, were selected and included in the study. Sixteen patients were treated with enucleation and 14 patients with decompression. All preoperative and control radiographic and clinical data were retrieved from the archives. The area measurement of cystic cavities was made on panoramic radiographs taken at preoperative (T0), 3-month (T1), 6-month (T2), and 12-month (T3) control periods with a software program. Intra-group and inter-group analyses were made to compare the reduction of cystic defects between two treatment methods. Results: The mean age of study patients was 45.2 ± 7.3. Eighteen of them were male and 12 of them were female. Statistically, a significant difference was not observed between decompression and enucleation groups at T0, T1, T2, and T3 control periods (P > 0.05). There was a statistically significant difference in the defect dimensions between all control periods in both decompression and enucleation groups (P < 0.05). Discussion: Decompression and enucleation of jaw cysts are both successful in reducing cystic cavities. However, there is no superiority between the two treatment modalities regarding the defect reduction at the 12-month control period.

Association of Serum Levels of Vitamin D with Blood Pressure Status in Northern Iranian Population: The PERSIAN Guilan Cohort Study (PGCS).

BACKGROUND: Evidence in the last decades has indicated an association between vitamin D and cardiovascular risk factors including blood pressure. The present study aimed to determine whether serum 25-hydroxyvitamin D is independently associated with blood pressure in a large population-based study. METHODS: The study was based on subjects from PERSIAN Guilan Cohort Study (PGCS), a prospective, population-based cohort study in Guilan, Iran. In 9520 men and women, aged 35-70 years, serum 25-hydroxyvitamin D, systolic and diastolic blood pressure were measured. Multiple logistic and linear regression analyses were conducted with adjustments for demographic factors (age and gender), anthropometric characteristics (waist circumference and body mass index), lifestyle variables (physical activity, alcohol, and smoking consumption), and renal function (serum creatinine). RESULTS: Fully adjusted linear regression analyses revealed a weak but statistically significant negative association between serum 25-hydroxyvitamin D levels and systolic blood pressure (ß = -0.02, 95% CI= -0.052 to -0.0001, P-value=0.04), whereas vitamin D status was not significantly associated with diastolic blood pressure (ß = -0.01, 95% CI= -0.026 to 0.009, P-value=0.3). Serum 25-hydroxyvitamin D status showed no significant association with the presence of hypertension (OR 1.09, 95% CI=0.94 to 1.25 for the lowest (25OHD <12 ng/mL) versus the highest (25OHD ≥20 ng/mL) category). CONCLUSION: Lower serum vitamin 25 (OH) D levels were associated with higher systolic blood pressure; however, it was not associated with diastolic blood pressure and presence of hypertension.

Efficacy and tolerability of fourteen-day sequential quadruple regimen: pantoprazole, bismuth, amoxicillin, metronidazole and or furazolidone as first-line therapy for eradication of Helicobacter pylori: a randomized, double-blind clinical trial.

The optimal pharmacological regimen for eradication of Helicobacter pylori (H. pylori) has been investigated for many years. This study aimed to evaluate the efficacy and tolerability of bismuth-based quadruple therapy (B-QT) and a modified sequential therapy (ST) regimens in eradication of H. pylori. A randomized, double-blind trial was conducted on 344 patients. Patients with H. pylori infection and without a history of previous treatment were randomized to receive 14-day B-QT (bismuth subcitrate 240 mg, pantoprazole 40 mg, amoxicillin 1000 mg, and clarithromycin 500 mg twice daily) or 14-day ST (bismuth subcitrate 240 mg, pantoprazole 40 mg, amoxicillin 1000 mg, and metronidazole 500 mg twice a day for seven days followed by bismuth subcitrate 240 mg, pantoprazole 40 mg, amoxicillin 1000 mg, and furazolidone 100 mg twice a day for additional seven days). Drug adverse effects were assessed during the study. H. pylori eradication was determined eight weeks after the end of treatment using 14C-urea breath test. Based on per-protocol and intention-to-treat, the eradication rate was significantly higher (p<0.05) in the B-QT regimen 91.9 % (95 % CI; 88.1-94.0) and 90.2 % (95 % CI; 86.3-92.9), respectively compared to the ST regimen 80.8 % (95 % CI; 76.6-84.9) and 78.1 % (95 % CI; 73.7-82.4), respectively. The severity of vomiting and loss of appetite were significantly higher in ST regimen (p<0.05). The B-QT regimen was more effective and safer than the ST regimen. Conclusively, it is suggested to assess the efficacy and safety of this regimen in longer studies, larger population, and in other communities.

Evaluation of Clinical Criteria for Performing Brain CT-Scan in Patients with Mild Traumatic Brain Injury; A New Diagnostic Probe.

OBJECTIVE: To investigate the risk factors that can be proper indications for performing brain computerized tomography (CT)-scan in patients with mild and moderate traumatic brain injury (TBI) in order to avoid unnecessary exposure to radiation, saving on costs as well as time wasted in emergency wards. METHODS: Data of patients with mild traumatic brain injury (TBI) referring to Emergency Department with age ≥2 years and primary GCS of 13-15 were examined including focal neurological deficit, anisocoria, skull fracture, multiple trauma, superior injury of clavicle, decreased consciousness, and amnesia. Brain CT-scan was performed in all the patients. Kappa Coefficient was used to determine the ratio of agreement of the CT indications (+ and ⎼) and multiple logistic regression to determine the relative odds of positive CTs. RESULTS: Overall we included 610 patients. One-hundred and one patients (16.5%) had positive and 509 (83.5%) had negative CT findings. Of positive CTs, the highest percentage was dedicated to high-energy mechanism of trauma. High-energy trauma mechanism (OR=1.056, 95% CI, OR, 1.03-1.04, P<0.001), superior injury of clavicle (OR=1.07, 95% CI, OR, 1.03-1.1, P<0.001) and moderate to severe headache (OR=1.04, 95% CI, OR, 1.02-1.05, P<0.001) were positive predictors of CT findings. The combined mean of positive symptoms equaled 0.29 ± 0.64 in negative CTs, but 5.13 ± 2.4 in positive CTs, showing a significant difference. (P<0.001). CONCLUSION: Abnormal positive brain CT in victims with mild TBI is predictable if one or several risk factors are taken into account such as moderate to severe headache, decreased consciousness, skull fracture, high-energy trauma mechanism, superior injury of clavicle and GCS of 13-14. The more the symptoms, the more likely the positive CT results would be.

Laboratory Tests, Liver Vessels Color Doppler Sonography, and FibroScan Findings in Patients with Nonalcoholic Fatty Liver Disease: An Observation Study.

OBJECTIVE: Determination of the amount of parenchymal damage in nonalcoholic fatty liver disease (NAFLD) is crucial to choose the best treatment and management. AIM: Here, the associations between laboratory data and severity of steatosis and fibrosis plus hepatic vessel Doppler indices in NAFLD patients were investigated. PATIENTS AND METHODS: Fifty patients (20 males and 30 females) with NAFLD criteria were enrolled. Fatty liver was graded by sonography (SGFL) and FibroScan (FGFL). In addition, liver fibrosis was graded through FGLF. Damages to the portal, hepatic, and splenic veins were evaluated by color Doppler/dopplex. Serum liver enzymes and C-reactive protein (CRP) were also measured. RESULTS: Significant association existed between SGFL and FGFL (P = 0.006). Portal vein pulsatility index (PI) and phasicity plus the triphasic and monophasic pattern of hepatic veins significantly associated with fatty liver grade evaluated by sonography. Splenic vein Peak systolic velocity and PI showed significant association with FGFL. Eventually, elevated liver enzymes and CRP significantly correlated with FGLF. CONCLUSION: We found that the severity of fatty liver is correlated with hepatic and portal veins damages; however, the degree of parenchymal fibrosis was independent to these indices and can be directly evaluated by FGFL. In addition, elevated liver enzymes and CRP correlated with the degree of fibrosis.

Noise-induced hearing loss in bus and truck drivers in Mazandaran province, 2011.

BACKGROUND AND PURPOSE: Noise-induced hearing loss (NIHL) is among the most prevalent and preventable work-related disorders. This study was conducted to evaluate the prevalence and severity of NIHL in bus and truck drivers of Mazandaran province in north Iran. MATERIALS AND METHODS: In a cross-sectional descriptive study, 2283 drivers were examined clinically and para-clinically, including measuring their fasting blood sugar, triglyceride and cholesterol levels. All participants were evaluated for the air and bone thresholds of both ears. Twenty-three individuals were excluded from the study because of conductive hearing loss. Data from 2260 drivers were analyzed using SPSS version 18. RESULTS: Of the drivers, 37.5% had hearing loss in the right ear and 41.8% of the drivers had hearing loss in the left ear in one or more frequencies of sound. Hearing loss was significantly more frequent in the left ear and in 6000 Hz followed by 4000 Hz. CONCLUSION: Our study showed that the prevalence and severity of NIHL is high in drivers of Mazandaran province. There was a correlation between hearing loss and age and driving work history. We recommend considering hearing conservation programs more seriously.

Gallstone disease founded by ultrasonography in functional dyspepsia: prevalence and associated factors.

The aim of this study was to evaluate the frequency of gallbladder stone in functional dyspepsia (FD) by abdominal ultrasonography and to determine the factors associated with this frequency in Guilan province. A total of 195 subjects who referred to outpatient clinic of Razi Hospital, a tertiary referral center (Guilan, Iran) to evaluate FD were included in this study. They were interviewed by using a questionnaire and underwent ultrasonography. Among the 195 subjects were 18.5% male and 81.5% female. The overall frequency of Gallstones (GS) was 19% (37/195) with 17% males and 83% female. In patients with dyspepsia, the presence of fatty liver evidenced by ultrasonography was 67% (131/195). From 131 patients with fatty liver disease 24 (18.3%) have been reported GS. The most frequent symptom in all participants as well as patients with GS and patients with fatty liver was abdominal pain (69.7%, 81% and 66%, respectively) followed by excess flatus. Risk factor associated with increased odds ratios (ORs) for the development of gall stones was diabetes mellitus (OR = 2.63). It also showed that gallbladder wall thickening was more common in patients with GS (OR = 36.63). GS disease was not significantly related to the age, gender, fatty liver, renal stone, history of hypertension (HTN) and hyperlipidemia (HLP), alcohol consumption and smoking status. Patients with FD especially if they have diabetes should be referred for upper abdominal ultrasonography for screening and early detection of GS disease.

A comparative study of metal artifacts from common metal orthodontic brackets in magnetic resonance imaging.

PURPOSE: This study was performed to compare the metal artifacts from common metal orthodontic brackets in magnetic resonance imaging. MATERIALS AND METHODS: A dry mandible with 12 intact premolars was prepared, and was scanned ten times with various types of brackets: American, 3M, Dentaurum, and Masel orthodontic brackets were used, together with either stainless steel (SS) or nickel titanium (NiTi) wires. Subsequently, three different sequences of coronal and axial images were obtained: spin-echo T1 -weighted images, fast spin-echo T2 -weighted images, and fluid-attenuated inversion recovery images. In each sequence, the two sequential axial and coronal images with the largest signal-void area were selected. The largest diameters of the signal voids in the direction of the X-, Y-, and Z-axes were then measured twice. Finally, the mean linear values associated with different orthodontic brackets were analyzed using one-way analysis of variation, and the results were compared using the independent t-test to assess whether the use of SS or NiTi wires had a significant effect on the images. RESULTS: Statistically significant differences were only observed along the Z-axis among the four different brands of orthodontic brackets with SS wires. A statistically significant difference was observed along all axes among the brackets with NiTi wires. A statistically significant difference was found only along the Z-axis between nickel-free and nickel-containing brackets. CONCLUSION: With respect to all axes, the 3M bracket was associated with smaller signal-void areas. Overall, the 3M and Dentaurum brackets with NiTi wires induced smaller artifacts along all axes than those with SS wires.

Doppler surrogate endoscopy for screening esophageal varices in patients with cirrhosis.

BACKGROUND: Portal hypertension is a common consequence of hepatic cirrhosis, which causes esophageal varices. Bleeding from varices has a high mortality rate. The present gold standard for diagnosing varices is endoscopy. Considering endoscopy side effects and patients' low acceptance, there have been always efforts for finding alternative diagnostic methods including Doppler ultrasonography (US). OBJECTIVES: The aim of the present study was to evaluate changes of Doppler indices in cirrhotic patients with and without esophageal varices. PATIENTS AND METHODS: Sixty six patients with known cirrhosis entered this cross-sectional study. Gastroscopy was performed for patients, and the first questionnaire was filled based on the Japanese Portal Hypertension Society guidelines. Then patients were referred for Doppler US of splenoportal system, and information was documented in the second questionnaire. RESULTS: Forty-four patients were male and 22 female. Forty six patients had esophageal varices, and 20 did not. There were no significant associations between splenoportal indices found by Doppler US, and presence of esophageal varices in patients. However, we found a negative association between platelet ratio to spleen diameter, and to splenic vein diameter. CONCLUSIONS: Neither of studied variables was perfect to differentiate cirrhotic patients with and without EVs. Endoscopy is still the gold standard diagnostic method for diagnosing esophageal varices in patients with cirrhosis. It seems that some of the splenoportal Doppler indices are promising, but more research and evaluation is necessary.

Diagnostic accuracy of secondary ultrasound exam in blunt abdominal trauma.

BACKGROUND: In stable patients with blunt abdominal trauma, accurate diagnosis of visceral injuries is crucial. OBJECTIVES: To determine whether repeating ultrasound exam will increase the sensitivity of focused abdominal sonography for trauma (FAST) through revealing additional free intraperitoneal fluid in patients with blunt abdominal trauma. PATIENTS AND METHODS: We performed a prospective observational study by performing primary and secondary ultrasound exams in blunt abdominal trauma patients. All ultrasound exams were performed by four radiology residents who had the experience of more than 400 FAST exams. Five routine intraperitoneal spaces as well as the interloop space were examined by ultrasound in order to find free fluid. All patients who expired or were transferred to the operating room before the second exam were excluded from the study. All positive ultrasound results were compared with intra-operative and computed tomography (CT) findings and/or the clinical status of the patients. RESULTS: Primary ultrasound was performed in 372 patients; 61 of them did not undergo secondary ultrasound exam; thus, were excluded from the study.Three hundred eleven patients underwent both primary and secondary ultrasound exams. One hundred and two of all patients were evaluated by contrast enhanced CT scan and 31 underwent laparotomy. The sensitivity of ultrasound exam in detecting intraperitoneal fluid significantly increased from 70.7% for the primary exam to 92.7% for the secondary exam. Examining the interloop space significantly improved the sensitivity of ultrasonography in both primary (from 36.6% to 70.7%) and secondary (from 65.9% to 92.7%) exams. CONCLUSIONS: Performing a secondary ultrasound exam in stable blunt abdominal trauma patients and adding interloop space scan to the routine FAST exam significantly increases the sensitivity of ultrasound in detecting intraperitoneal free fluid.

Ultrasonographic evaluation of long-term results of nasal tip defatting in rhinoplasty cases.

OBJECTIVES/HYPOTHESIS: Nasal skin thickness has an important role in aesthetic results of rhinoplasty. The aim of this study was to evaluate the long-term results of tip and supratip skin defatting technique in rhinoplasty subjects using ultrasonography. STUDY DESIGN: Prospective, randomized, case-control study. METHODS: Among 111 rhinoplasty cases referred to a university hospital between February 2010 and September 2011, after physical examination and measuring the nasal tip and supratip skin thickness by ultrasonography, a total of 55 patients with thick and moderate skin were randomly allocated for rhinoplasty using one of the following methods: rhinoplasty with (case group) and without (control group) defatting tip and supratip skin. Ultrasonographic evaluation of the skins was repeated 1 and 12 months after surgery, and the data were analyzed by Wilcoxon and repeated measure tests using SPSS 17 software. RESULTS: Twenty-eight of 55 candidates (10 men, 45 women; mean age, 25.1 ± 7.6 years) underwent skin defatting during rhinoplasty; the other 27 patients did not undergo this procedure. Forty-four patients completed the study. Thickness of tip and supratip skin was not statistically different before surgery and during follow-up evaluations in defatting and nondefatting technique groups (P = .7). CONCLUSIONS: Defatting techniques have no effect on reducing tip and supratip skin thickness after rhinoplasty in moderate to thick skins.

Assessment of ureterovesical jet dynamics in obstructed ureter by urinary stone with color Doppler and duplex Doppler examinations.

This study was designed to evaluate ureterovesical jet dynamics in obstructed ureter and to compare it with those of contralateral unobstructed side. Forty-six patients with diagnosis of ureteral stone, based on imaging findings in computed tomography were enrolled in this study. The gray-scale ultrasound exam from both kidneys and urinary bladder was performed. Then, ureterovesical jet characteristics including ureteral jet frequency, duration and peak velocity were assessed by color Doppler and duplex Doppler studies in both obstructed and unobstructed ureters by a radiologist, 15-30 min after oral hydration with 750-1,000 mL of water. When compared with contralateral normal side, the ureterovesical jet in obstructed ureter showed less frequency (0.59 vs. 3.04 jets/min; P < 0.05), shorter duration (1.24 vs. 5.26 s; P < 0.05) and lower peak velocity (5.41 vs. 32.09 cm/s; P < 0.05). The cut-off points of 1.5 jets/min, 2.5 s and 19.5 cm/s for difference of ureteral jet frequency, duration and peak velocity between obstructed and contralateral normal ureters yielded sensitivities of 97.8, 95.6 and 100 % and specificities of 87, 87.9 and 97.8 %, respectively for diagnosis of ureteral obstruction. Given the safety of Doppler study and significant differences in flow dynamics of obstructed versus unobstructed ureters, our findings demonstrated the utility of Doppler ultrasound examination as a useful adjunct to gray-scale ultrasound by improving the accuracy of ultrasound exam in diagnosis of ureteral obstruction.

Knee sonography as a diagnostic test for medial meniscal tears in young patients.

PURPOSE: To prospectively evaluate whether age of patient affects diagnostic accuracy of sonography and magnetic resonance imaging (MRI) in the diagnosis of medial meniscal tears. METHODS: We prospectively evaluated 74 consecutive patients (54 males and 20 females), in two different groups [group A (37 patients ≤ 30 years; mean age: 23.5 ± 5 years) and group B (37 patients > 30 years; mean age: 43.5 ± 9.35 years)] with clinical suspicion of medial meniscal tear. After inclusion, patients underwent ultrasonography and then MRI for signs of tearing. The ultrasonographic and MRI findings were compared with arthroscopic findings, which served as a gold standard for accurate detection of meniscal tearing. RESULTS: The sensitivity, specificity, positive and negative predictive values and accuracy of ultrasonography in detecting medial meniscal tears in group A were 100, 88.9, 96.5, 100, 97.3% and in group B were 83.3, 71.4, 92.6, 50, 81.1%, respectively. The sensitivity, specificity, positive and negative predictive values and accuracy of MRI in group A were 100, 88.9, 96.5, 100, 97.3% and in group B were 96.7, 85.7, 96.7, 85.7, 94.6%, respectively. CONCLUSIONS: Given the fact that the sensitivity and specificity of the results of knee sonography matched that of MRI in patients who were 30 years old or less, we suggest ultrasonography as an effective initial investigation for tears of medial meniscus in this group of patients. Patients with negative ultrasonographic findings will need no further investigation. LEVEL OF EVIDENCE: Diagnostic studies-investigating a diagnostic test, Level II.

The discovery of a Persian family with a form of Birt-Hogg-Dubé syndrome lacking the typical cutaneous stigmata of the syndrome.

PURPOSE: This study was performed in 24 members of a family with spontaneous pneumothorax to test clinical suspicion of Birt-Hogg-Dubé syndrome (BHDS). METHODS: Computed tomography scan was performed for confirmation of pneumothorax, while genetic tests were done using real-time quantitative polymerase chain reaction. RESULTS: Genetic studies showed a deletion of exon 1 in the FLCN gene in the index case as well as nine other individuals, including two with clinical phenotypes of pneumothorax and seven who are symptom-free to date. CONCLUSIONS: Proper imaging and taking accurate family history could be the keys to test clinical suspicion in some syndromes, including BHDS.

Ultrasonic measurement of common carotid intima-media thickness in type 2 diabetic and non-diabetic patients.

BACKGROUND: Diabetes mellitus is a widespread disease. Its vascular complications can be characterized by arteriosclerosis formation in carotid arteries. Due to its delayed diagnosis resulting in more complications in Iran, it seems that screening diabetic patients is mandatory. OBJECTIVES: The aim of this study was to compare the intima-media thickness (IMT) of carotid artery in diabetic and non-diabetic patients. PATIENTS AND METHODS: This is a cross-sectional study, which included 80 participants (40 diabetics and 40 non-diabetics). By using ultrasound, bilateral IMTs of the distal carotid were measured and the data were analyzed using ANOVA and multivariate regression tests in SPSS 14. RESULTS: The mean IMT was 0.97 in diabetic patients and 0.63 in non-diabetics (P < 0.001). Age and gender had significant positive effects on the increase of IMT (P < 0.05 and P < 0.005, respectively for age and gender). Past medical history of coronary heart disease (CHD) and cerebrovascular accident (CVA) in diabetes is associated significantly with an increase in IMT (P =0.019 and 0.027 respectively). Other confounding variables such as smoking, history of hypertension (HTN) and hyperlipoproteinemia (HLP) in diabetic patients showed no significant relationship with the increase of IMT. CONCLUSIONS: Although measuring the IMT of the carotid artery by sonography is a useful tool for screening diabetic patients, more studies are needed for determining how to use these measurements in promoting the patients outcomes.

Effect of hypertransfusion on extramedullary hematopoietic compression mass in thalassemia major: a case report.

Hereby we report a patient with thalassemia major having extradural cord compression at T3-T9 levels due to a mass of extramedullary hematopoiesis (EMH) tissue, whose treatment was successful with hypertransfusion therapy alone. The patient was a 23-year-old man who had not received regular blood transfusion since two years before admission. He suffered from paraparesis with a history of progressive lower limb weakness for 2 months. MRI of the spinal cord demonstrated thoracic extramedullary hematopoietic mass causing spinal cord compression. The patient demonstrated a significant response to hypertransfusion and improvement in the neurologic status started a few days after treatment. Almost complete resolution of the mass was seen in spinal MRI one week after hypertransfusion. Hypertransfusion seems to be a useful method for treatment of spinal cord compression due to a hematopoietic mass. It may be used as the first line therapy.

Spirometric reference values for healthy adults in the Mazandaran province of Iran.

OBJECTIVE: One of the major issues in the use of spirometry is the evaluation of the values obtained in comparison with standardized reference values. Such reference values should be determined by studying populations similar to the population in which they are intended to be used. Considering the anthropometric differences among races and the effect of regional issues, such as climate and air quality, it is recommended that these standards be set and used regionally. The objective of this study was to measure the spirometric values in residents of the Mazandaran province in Iran, as well as to determine which standardized reference values most closely correlate with the values obtained and to devise predictive equations for the target population. METHODS: This was a cross-sectional study of 1,499 volunteers, from whom demographic and anthropometric data were collected. After having been instructed in the correct procedure, each volunteer underwent spirometry. From each volunteer, we obtained three spirometry curves that met the acceptability criteria established by the American Thoracic Society. The test with the highest values of FEV1 and FVC was employed in the analysis. RESULTS: We observed significant correlations between the measured values and the reference values, for both genders. The strongest correlations were with the European Respiratory Society reference values and with the 18-20 year age bracket. The predictive equations devised were based on the regression coefficients obtained and the demographic data collected. CONCLUSIONS: Our results show that the European Respiratory Society standard is the most appropriate standard for use in the population studied.